CSE5810: Intro to Biomedical Informatics

1. CSE5810: Intro to Biomedical Informatics Mobile Computing to Impact Patient Health and Data Exchange and Statistical Analysis Presenter: David N. Etim

2. Outline • Introduction • Research Objectives • Mobile Work in Health Care • Electronic Medical Records • Studies on Patient Care • Research Design, Methods, Analysis • Comparison of Studies • Physician-Patient Relationship Effects • Summary

3. Introduction • Health information sharing between patients and health care providers: • Diagnosis improvement • Increase patient’s understanding • Promotes independent care • Researchers want to educate and empower patients to learn more about health data sharing • Patient-Physician interaction is encouraged, leads to patient education of self-care

4. Research Objectives • Compare techniques and experiments in how mobile computing impacts clinical data exchange • How does it affect data analysis? • How is it helpful to patients to view medical records? • View strengths and weaknesses of patient interaction with online medical records • Compare and contrast between different views and information about how medical data is shared

5. Mobile Work in Health Care • What exactly is mobile work? • Usage of mobile technologies in varying degrees to accomplish tasks • Mobile work within hospitals is complex and sophisticated • Mobility of resources and individuals are at the center of patient diagnosis, treatment and care • Health care scenarios contain flexibility and work well with information exchange

6. Electronic Medical Records • Digital version of a paper chart containing all of patient’s medical history from one practice • Mostly used for diagnosis and treatment • Benefits: • Tracks data over time • Identifies patients due for preventive visits and screenings • Monitors how patients measure up to parameters • Vaccinations, blood pressure readings, etc. • Improves overall quality of care

7. Electronic Medical Records • What’s the difference between EMRs and EHRs? • Electronic Medical Records contain standard medical data collected in a provider’s office • Electronic Health Records (EHRs) consists of standard clinical data along with more comprehensive patient history • EHRs are designed to hold and share information from all providers involved • Data can be created, managed, and consulted by providers and staff • EMRs aren’t able to allow a patient’s health record to move with them to other health care providers, hospitals, and vendors

8. Studies on Patient Care • Studies done in the area of health data exchange involving mobile computing • Comparison of two studies: • Testing Web-based care management of glycemic control using a shared electronic medical record with patients who have type 2 diabetes • Assessment of patients using online medical records and impact on patient care and clinical operations

9. Study #1 Web-based care management

10. Introduction • Study aimed to improve glycemic control using a care manager • Wagner’s Chronic Care Model • Four Domains: • Self-management support • Delivery system design • Clinical information systems • Clinical decision support • Trial conducted at the University of Washington General Internal Medicine Clinic

11. Research Design and Methods • Participants enrolled in a 12-month open, randomized, controlled trial with parallel group design • 7,000 patients used in trial • Patients with type 2 diabetes randomly assigned to group receiving online care management • EMR data used to identify potential participants between ages of 18 and 75 • Patients excluded from study because of trial criteria • participated in pilot study, have major psychological illness, non-English speaking

12. Research Design and Methods • Participants introduced to Web-based program • Encouraged to review online records, send weekly blood glucose readings • Send e-mail updates if necessary • All providers used same electronic medical record • Patient specific reminders for measurement of Gamma-Hydroxybutyric acid(GHb)

13. Results • Analysis of outcome included all randomly allocated participants with available outcome data • Primary analysis used linear regression with change in GHb as dependent variable • Trial was designed to have 80% power to locate a difference of 0.5% in GHb concentration • Systolic and diastolic blood pressure, cholesterol levels, and usage of health care services didn’t create differences between groups

14. Statistical Analysis

15. Statistical Analysis

16. Study #2 Electronic communication to patients

17. Introduction • Clinical trial conducted in specialty clinic at University of Colorado Hospital • Patients with Class II or Class III symptoms of heart failure • Project Objectives • Assess how a patient-accessible online medical record affects patient care and clinic operations • Providing patients with secure access to their medical records using the Internet

18. Intervention • Participants in intervention group were given a username and password for System Providing Access to Records Online (SPARRO) • SPARRO provides a Web interface • Medical record • Educational guide • Messaging system • Patients in control group continues to receive standard care in practice

19. Data Collection • Throughout study period, dates were tracked for when patients used SPARRO • If a single participant used a component of SPARRO multiple times on a given day, counted as “patient hit day” for that component • Messages tracked and sent through SPARRO system to providers • Mobile phone messages tracked through review of medical records and logs

20. Results • The intervention group was higher in adherence compared to being at a lower rate in self-efficacy • more emergency department visits

23. Comparison of Studies • Both studies and others previously have demonstrated improvements in adherence and satisfaction with physician-patient interaction • Patient-accessible medical records increased workload • Great efficiency in both techniques in systems • Patients learned that data is not up to date unless having clinical encounters or involved in lab studies • Electronic messaging does not substitute for phone communication

24. Effects of Physician-Patient Interaction • Physician-patient relationship may be an important influence on patients’ health outcomes • Patients either have positive or negative reaction to how physicians lead their treatment • Sense of comfort • Optimism/Pessimism about treatment • Functioning better from physiological and behavioral aspects • More information collection and conversation relate to better health statuses

25. Summary • Technology is more capable than ever for providing patients with access to online records • Medical records are more convenient accessed through the Web, mobile devices, mostly helpful for patients • Patients review records multiple times and have assistance of others for comprehension and progress • Disruption is little to none for access granted to patients while continuing clinical operations